India is home to a bad healthcare system. That’s why we need to live in fear of the next generation of diseases, says Samrat Chakrabarti
TO THE growing list of potential cataclysms facing the human species — climate change and nuclear holocaust — we must now add an old foe. Bacteria. Antibiotics, our wonder drugs against disease-causing bacteria, is proving ineffective as new strains of bacteria like the NDM 1 (often referred to as superbug), are born, already resistant to our medicines. While this happens worldwide, India seems to be an ideal breeding ground for the next generation of diseases to which we have no answers.
The problem of antibiotic resistance was anticipated around the same time that the first antibiotic was. Sir Ian Fleming, who discovered wonder drug penicillin, also found that the bacteria grew resistant to the penicillin if it was exposed to too little of it or for too short a time. Evolution applies the old adage — if it does not kill you, it makes you stronger. With every new generation of living organism, natural selection places new characteristics on the organism that help it survive better. The shorter the lifespan of the organism and higher the rate of growth, the faster the adaptation. These are the risks of an incomplete antibiotic regimen or erratic pill-taking — the medicine falls below a critical level, allowing the bacteria, with its short lifespan and huge rate of growth, to grow quickly. With the widespread use of antibiotics, the emergence of resistant strains of bacteria was expected. But, a bad healthcare system, like the one in India, exacerbates the situation. A new bacteria might soon become resistant to every drug we have.
The first problem is the irrational prescription of drugs. Dr VK Bhargava, senior consulting physician at Apollo Hospital, Hyderabad, says, “There’s a high incidence of inappropriate use of antibiotics in the country. If you don’t know what the target is, you’ll never know where to hit. In India, more than 90 percent of cough is caused by viruses. And yet, doctors regularly prescribe antibiotics for cough. Antibiotics are for bacteria, not viruses. The doctors give antibiotics to impress the patient. Half the problem would be solved if patients asked their doctors if a prescribed antibiotic was strictly necessary.”
But the main problem seems to be with regulation. Chandra M Gulati, editor, Monthly Index of Medical Specialities says, “There is no regulation of antibiotics in the country. Antibiotics that ought to be the preserve of superspeciality hospitals are available at your local chemist and just about any kind of doctor can prescribe any kind of antibiotic. Go to three doctors with the same problem and you will get three different antibiotics. We still allow for fixed dose combinations, which is not allowed in the developed world.”
‘Doctors prescribe antibiotics for cough. They are for bacteria, not viruses,’ says Dr VK Bhargava of Apollo Hospital, Hyderabad
Fixed dose combinations contain two or more antibiotics in a single pill thus exposing bacteria to different kinds of antibiotics and increasing the danger of resistance. “It’s nothing more than a marketing gimmick,” warns Gulati.
In the absence of a nationwide survey, quantifying the problem of drug resistance is difficult, but consider this — India’s No. 1 public health malaise is tuberculosis (TB). We contribute a fifth of the TB cases worldwide. Public health professionals are grappling with a man-made problem of multi drug resistant TB where even a cocktail of drugs is proving insufficient. Twenty-six percent of such cases worldwide come from India.
Maybe it’s time our country had a national antibiotic use policy.